20142015 CBA K-2 1
APPENDIX K-2
FACULTY EDUCATIONAL ACHIEVEMENT INCENTIVE
APPLICATION
(To be completed following completion of approved coursework/degree program)
Attach copy of approved Appendix K-1
Name Date
Employee Identification Number
Department and Campus
BA/BS MA/MS MA+/MS+ DOCTORATE
LEVEL APPLIED FOR
LEGIBLE TRANSCRIPT* COPIES MUST BE ATTACHED
COURSE
NUMBER
COURSE
TITLE
COLLEGE
OR
UNIVERSITY
GRADUATE OR
UNDERGRADUATE
SEM. HRS
*An official copy of each transcript must be placed on file in Human Resources and a
legible copy of each transcript must be attached.
20142015 CBA K-2 2 6-8-12
SPECIAL CERTIFICATION PROCESS
COURSE
NUMBER
COURSE
TITLE
DESCRIPTION
TOTAL
HOURS
Faculty Member Date
Recommend ______ Not Recommend ______
Immediate Supervisor Date
Comments:
Recommend ______ Not Recommend ______
Dean Date
Comments:
Approved _______ Not Approved________
Vice President of Academic Affairs ____________________________ Date _____________
Comments:
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